Step up to a breathtaking view

Montmorency Falls

Taller than Niagara, the Falls carve into the countryside

Less than half an hour from Quebec City by car, Montmorency Falls offers not only a spectacular view of a natural wonder, but several opportunities to actively participate in that wonder.
After paying $12 to park your car (or park outside before the gate and pay nothing), you quickly come face-to-face with the white wall that is the falls, plunging 83 m (272 ft)—higher than Niagara Falls—to join the St. Lawrence River. (Several tour bus lines also visit the falls.)
Upon entering the tram station and gift shop area, you have the option of paying another $12 to take the tram to the top of the escarpment ($14 round-trip) or wandering along a bridge and path to the base of the falls where you are bathed in spray. Here, you are faced with the question of whether you want to climb 487 steps and save yourself some money.
This is not for the weak-of-the-knees, although there are several rest areas along the climb to catch your breath and take photos. To give some sense of the undertaking, I am about 280 lbs but walk quite often, and I was winded and my legs tired upon reaching the summit, but quickly recovered.
Once at the top, you walk along a short trail to reach the bridge that spans the top of the falls with the river on one side and a sheer drop on the other. From here you have a spectacular view of the falls and even Quebec City, and I am happy to report that the bridge is very sturdy, placating those of us who fear heights.
A recent addition to the falls is a dual zipline that allows those brave few to slide right across the face of the cascade. I got nauseous simply watching other people experience the adventure.
And when you get back down to the bottom—my friend and I took the tram down—you can check out the small gift shop and snack counter. Given the stair climb, we think the site is really missing out on an opportunity to market “I survived” t-shirts.
The experience is definitely worth the trip out of town and will give you something to talk about for quite some time (especially if you climbed those ruddy stairs).

Toronto Marlies crunch Syracuse

As the New Year arrived, my beloved Toronto Marlies played host to their cross-border rivals Syracuse Crunch.

The New York team is well named, with a history of pounding their opponents physically if not always on the scoreboard…and the local boys were ready to give as good as they got.

Saturday, January 2: Toronto 3 – Syracuse 2 (YouTube highlights)

Sunday, January 3: Toronto 3 – Syracuse 2 (OT) (YouTube highlights)

The hard-hitting series sets up an interesting three-quel when Syracuse visits Toronto’s Ricoh Coliseum yet again on Wednesday, January 20.

When numbers fail (DDNews commentary)

Dutee Chand

Athletics bodies have questioned whether sprinter Dutee Chand has an unfair advantage.

What is normal?

The question may sound absurdly philosophical, particularly for the pages of DDNews, and yet healthcare directly or indirectly deals with this question on a daily basis. And the clinical response can be as life-altering as the societal and political responses that we see on the news every night.

An entire industry has been created to test and monitor health using various diagnostic assays, to the most recent of which DDNews dedicates an entire section. In some cases, the results of these assays are binary—the classic example is being a little bit pregnant. But in most cases, healthy (or normal) falls within a range of values—think LDL/HDL, blood glucose or body temperature.

In part, this is a recognition that results can vary within an individual throughout the day, and on the larger scale, because individuals are products of their genetics and environments. What might be a healthy level for me in Toronto may actually be limiting in Johannesburg.

But even with the recognition of variability, we must always be vigilant in questioning how the normal range was defined. Was it based on the combined results of 200 male Manitoba bush pilots (I have read such a study), or a sampling of tens of thousands of individuals from around the world? If only for economic reasons, the former is more likely to be the case.

In 2011, Boston University’s Shalinder Bhasin and colleagues examined this challenge by identifying reference ranges for testosterone in healthy men. Suggesting that these ranges “have been derived previously mostly from small convenience samples or from hospital or clinic-based patients,” they examined a much larger cohort from the Framingham Heart Study (Gen 3), publishing their results in the Journal of Clinical Endocrinology & Metabolism.

Although most values were consistent with historic values, their lower limit of total testosterone was higher than that used historically but was “closer to the thresholds associated with sexual and physical symptoms in a recent investigation of older men.” Thus, when it comes to testosterone, it seems (sample) size matters.

But what about the outliers, the norms who don’t fit the norms and the unwell who do?

As a bit of a sidestep, just over a year ago, the International Association of Athletics Federations (IAAF) banned Indian sprinter Dutee Chand from competing in sanctioned competitions because her blood testosterone levels fell into the normal range of male athletes rather than that of her female competitors. Thus, the group decided, she would have an unfair advantage over her fellow runners.

What made this ruling particularly challenging, however, was that Chand’s testosterone levels were natural; they did not come about from doping. Her levels simply fell outside of the clinically accepted norm for women.

Closer to home for me are two friends who live with symptoms of hypothyroidism and have resorted to alternative medicine because they were dissatisfied with the medical establishment. In both cases, standard thyroid function tests suggest they fall within the normal range and therefore would not benefit from standard treatment. This may be true, but neither knows because it was never tried.

Admittedly, these are anecdotes. Three women struggle because they do not fit ascribed definitions, whether of health or pathology. And for every anecdote I can list, the healthcare establishment can rightly point to hundreds if not thousands of individuals who fit the defined ranges of normalcy.

It’s a conundrum I have discussed previously: healthcare is population-based while health is personal.

In our zeal to standardize healthcare and make medicine more scientific, we have to be careful not to ignore the natural variabilities of individuals within those populations. So-called normal ranges should suggest action, not dictate it.

Even as we pursue the precision medicine mandate, spending billions (and possibly trillions) of dollars on expanding our understanding of human biology and generating technologies to value every facet of it, we have to make sure that our knowledge doesn’t blind us to the patient’s truth. If that happens, if all we accomplish is a bigger monolith, then we have failed in the mission.

As to Chand’s racing career, the Court of Arbitration for Sport recently overturned the IAAF’s rule, giving them two years to prove that the higher testosterone levels truly give the runner an unfair advantage.

DDNews_0915
Originally published in DDNews in September 2015, this is one of a series of commentaries I write each year. If you’re interested in recent technological and business innovations in biotech, pharma and healthcare, you should check the publication out.